Living with Pain: The Pharmacy Crawl in Florida

Living with Pain: The Pharmacy Crawl in Florida

Keyanna, a woman living in north Florida, knows all about the fallout from Florida’s well-intentioned but short-sighted crackdown on opioids. New state laws and regulations that govern opioid prescriptions have brought heavy handed scrutiny from law enforcement agencies on Florida physicians, pharmacists and pain patients.

Like many people who suffer from chronic pain, Keyanna has a frightening list of diagnoses: two failed back surgeries, arachnoiditis, reflex sympathetic dystrophy, Hepatitis B, chronic obstructive pulmonary disease, arthritis, stage 4 endometriosis, myofacial pain, fibromyalgia and chronic fatigue. Who could doubt the harrowing pain Keyanna lives with minute-by-minute, every day of her life?

Keyanna lives in a rural county where medical care and pharmacies are in short supply. On May 9, she received only a part of her prescription for methadone and was told by her pharmacist to return the following week, when he would fill the remainder of her prescriptions. But when Keyanna arrived days later, the pharmacist told her — with no explanation — that he would no longer fill her prescriptions and she’d have to go elsewhere. He didn’t give Keyanna a referral; he simply abandoned her to pain and possible withdrawal symptoms if she didn’t find another pharmacist.

After numerous failed attempts to locate a willing pharmacist, Keyanna sank into withdrawal from methadone. This doesn’t mean she was addicted, it simply means that Keyanna couldn’t abruptly stop her medication. She needed to come off the medicine slowly under a physician’s supervision.

Keyanna’s sister contacted a pharmacist a hundred miles away, who agreed to fill Keyanna’s outstanding prescriptions. But after driving for two hours, the sister was turned away by the pharmacist, saying that he couldn’t fill a prescription for methadone for a patient living more than ten miles from the pharmacy.

As of this writing, Keyanna and her family have failed in all efforts to locate a sympathetic pharmacist – or, in my estimation, a compassionate ethical pharmacist willing to care for a desperately sick patient.

Unintended Consequences

Keyanna lives in a state that is the poster child for prescription drug abuse.  Florida pill mills saw patients from all over the southeastern United States who were ostensibly seeking relief from pain. In reality, many of these medicine “seekers” were opioid addicts and pushers who illegally obtained prescriptions to resell to non-patients. These pill mills fanned the fires of drug diversion, addiction and death.

Florida’s legislature and governor enacted laws to combat these problems. But the new regulations have had unintended consequences that go far beyond the needed shuttering of pill mills. Among the many problems pain patients now face in Florida, one of the most frightening is the increased discretion that pharmacists have in filling opioid analgesic prescriptions for legitimate pain patients like Keyanna.

Donna Ratliff is a tireless pain care activist in Lithia, a suburb of Tampa. Several months ago she started a private Facebook page called “The Pharmacy Crawl” that is dedicated to changing opioid prescription laws so that they accommodate legitimate pain patients. Members of her group also help each other find pharmacists willing to fill their lawful prescriptions. Keyanna, who asked that her last name not be used, is a member of the “The Pharmacy Crawl.”

Ms. Ratliff, who suffers from constant pain, says Florida’s crackdown on pill mills has instilled fear in pharmacists up and down the state. Several pharmacies have been temporarily shuttered by overzealous regulators. Many pharmacists are worried they could lose their licenses if they fill too many prescriptions for opioid medicines or fill prescriptions that call for high doses of the analgesics.

So they turn people like Keyanna away.

How could anyone in the healing arts allow this situation to continue? How could a pharmacist turn away a patient he knows will be, or already is, in withdrawal? Withdrawal is no picnic. There is increased pain, profuse sweating, nausea, diarrhea, vomiting, chills, sleep and mood disturbances.

What prevents one of these pharmacists that Keyanna contacted from picking up the phone and discussing her case with Keyanna’s physician? Why couldn’t one of them check Keyanna out on that state’s Patient Monitoring Program that lists patients with valid prescriptions for opioid medicines? Minimal questioning would determine that Keyanna is a legitimate patient.

These are small inconveniences when compared to the suffering of Keyanna and the thousands like her suffering in pain, despair and silence.

This atmosphere of fear and suspicion in Florida and other states about opioid use is in all likelihood increasing the numbers of suicides among patients who can’t find appropriate care. We know that depression and suicidal thoughts are higher among pain patients than in the general population.

We need to do all we can to stop diversion and misuse of these powerful analgesics. But our efforts need to be grounded in good research that generates valid and reliable evidence. We also need to be fair and protect access to these lifesaving analgesics for legitimate pain patients.

The medical community in Florida needs to end Keyanna’s suffering now.

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here

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There are 17 comments for this article
  1. Rhonda Poole at 8:55 pm

    I am a legitimate pain management patient. I have been in 5 serious car accidents in my life. According to my MRIs, I have herniated disks, bulging, disks, and one protruding disk that is pushing into my left S1 nerve root in my spinal cord. Because my fist injury was in 1987, I have developed both spondylosis and facet joint arthropathy (arthritis) in my spine. The conditions are in both my cervical and lumbar areas of my spine. I can barely walk further than 30 feet without actually sitting down to rest. When I first get up in the morning and throughout the day, I experience excruciating pain. Without my pain medication, I am not able to function. The pain has gradually increased with age and became intolerable when I reinjured my back in another car accident on December 23, 2010. Until that time, I was able to get by with ibuprofen and Tylenol. I am not a drug addict. I am a functioning member of our community. I worked steadily for 25 years, 15 of those years at GTE/Verizon in the call center. Although I am 49 years old, I decided to return to college and finish my degree. I graduated, with honors, from PHCC in July of this year. I am starting as a junior at Saint Leo University on August 21. I don’t take an exorbitant amount of medication. My prescriptions amount to: oxycodone 15 mg – 5 times per day, methadone 10 mg – twice per day, flexaril 10 mg – twice a day, citalopram (generic celexa) 40 mg – once per day, clonazepam .5 mg – PRN up to two per day, which I rarely take when my pain medication is working. Due to not being able to fill my prescriptions, this month, yesterday my doctor changed me from oxycodone to hydromorphone 4mg – 5 times per day. If I could not get my medication, I would have to get a walker to use at school if I wanted to continue. For the last 6 or 7 months, I have to go to over 40 pharmacies looking for my medication. All the pharmacists tell me either they do not have it available or give me some other reason, such as they only fill prescriptions for their regular patients. They look at me as though I am trying to do something illicit. It is dreadful, last month it took me two weeks to find my medication. Fortunately, I was able to rely on my surplus that had built up slightly. I went five days with no medication and could barely get out of bed, due to both pain and withdrawal symptoms. This month it took me six days to find it and again I was laid up in bed. Please do not take pain medication away from people who need it, from people who do not take very much, but just enough to get by. I am only 49 years old and scared to death that I am going to be in a wheel chair or have to use a walker.

  2. Laurel McDonough at 2:22 pm

    Thank you for this article. Having been a hospice RN I made sure my patients were comfortable and pain free. However, when I needed help with pain I met resistance from both doctors and pharmacies. One rheumatologist put me on a research study for a new pain medication for which she was receiving funding. When I was finished with the study she told me that I needed to find another doctor for my pain relief! Several times I have had to go from one pharmacy to another to find a pharmacy that had my medication in stock, often depending, it seems, on who is behind the counter. I once had a pharmacist call my doctor to verify the prescription, but even when the doctor told the pharmacist that it was a legitimate script, the pharmacist continued to treat me poorly. It is wrong to not allow legitimate pain patients the dignity of pain relief.

  3. sheryl at 7:27 am

    This is a huge problem for a legitimate pain sufferer like me. I broke my back in a motorcycle accident years ago. I already had scoliosis since childhood it was so severe I wore a brace all my life. Five years ago a closet colapsed on me and dislocated my jaw. I had to have major reconstructtive surgery. The surgery was not sucessful and now they want to put a metal joint in ny jaw. I suffer from fibromyalgia bow as well due to the trauma I’ve been through. My pain is so sever without my medication I can’t move I can only curl up in a fetal possition and cry. I am a mother of three. I own a business and I employ several people. I am also a volunteer at the local jail helping wemon. I an not a bad person, but I am treated horribly every month when I have to go from pharmacy to pharmacy looking for me meds. I am told they won’t take my insurance because they cant make any money off of me that way by one place. Others say only cash. They don’t have the medicine anywhere and if they do they wing give it to me because I have insurance. I have so many stories of how badly I’ve been treated at these pharmacies. You have no idea how hard it is to be in so much pain and have to go to. 30 stores a day. I’ve had to go 10 days each month without my medicine because I can’t find it. This is wrong!! Someone has to have some compassion for us. We are not criminals. Without my medicine I can’t no a productive citizen. This situation has already cost me two of my contracts which in turn meant I had to lay several people off. I hope someone can change this.

  4. Keyanna at 4:11 pm

    Hello Mark,

    I dearly appreciate this article you have written about me regarding the much flailed journey I’ve been on. Qnd I feel the need to deeply apologize for not commenting much, much sooner, however, I’ve been terribly unwell from this “Crossfire” I have been caught in. This journey ‘Monumentel Crash of a Healthcare System in Florida … has not ended for me. I cannot even find a new Doctor to treat my Intractable Chronic Pain!! And I am at my witts end.

    Please accept my enormous Thanks for your Concise Abilities As A Great Journalist and Person.
    I so appreciate you.

    Brightest Blessings,
    Keyanna Otholt

  5. Kat at 9:46 pm

    My question, why did they implement the prescription monitoring service in Florida? This was supposed to be put into effect so they would stop drug and doctors shoppers. So now they have it in place, yet you cannot get a script filled almost anywhere and it’s become almost impossible to fill a legit script since then. It usually takes 2 days to 2 weeks to find someone willing to fill for you, if at all. If you find a place to fill you are very, very lucky.

  6. Nancy at 9:44 pm

    I live in Florida and if the pharmacists would bother to use the database that was set up, inappropriate narcotic Rx’s would not be filled, and legitimate ones could be filled confidently. They had no problems filling Rx’s without checking them out until a year ago. My husband uses pain medicine every day for 5 years since he ruptured two disks in his neck and has nerve involvement. The pharmacists knew him by name, we had all the family’s Rx’s filled there for almost 20 years. Never a question about his monthly pain Rx until last year. Now he is forced to take his Rx to pharmacy after pharmacy and even went through 2 days of withdrawal in February until he found a private pharmacist that filled the LEGAL and LEGITIMATE Rx. Pharmacists should have a duty to fill Rx’s and to take the time to call the doctor or check the database if they are not sure.

  7. Christine at 11:09 am

    Florida at it again. They do not care about their citizens and they make many laws with unintended consequences for many people. Florida wants government money and this gets them the money like all the other laws they have on their books. They DO NOT use common sense when making laws. They treat everyone with one brush, no matter the laws. They do not care about who gets hurt in the process. This is just another one of Florida’s flaws.

  8. Radene at 1:47 pm

    Brilliant article, Mark! I am so grateful to see that American News Report has brought on someone as a columnist who can add some balance to the national media’s normally over-biased reporting on chronic pain issue. Like the woman in your story, I too had failed back surgeries and got adhesive arachnoiditis which is insidious, incurable and wretchedly unstoppable. The only, ONLY treatment for arachnoiditis is continual pain management. Without that, not only is she suffering immensely because the pain never lets up but her body is constantly being berated by the stress the pain puts on her heart, her hormones, her entire system is being pummeled on the inside. Plus, with arachnoiditis, it is the central spinal cord itself that is generating the pain because every movement is causing microscopic tears in the nerves themselves due to them being stuck permanently in the ARACHNOID lining of the spinal cord. The pain is new every moment of everyday. Bringing such a case to the public, Mark, I hope they begin to see how much worse things have become for those with real, constant pain, like you and your story subject. Thank you again for such a relevant story

  9. E11 at 9:56 am

    Very well written article! This is just ONE example the War on Drugs gone insane, of so many. I applaud this reporter’s ability to articulate the many aspects that a pain management patient has to endure; We need more articles like this to combat the media attacks on pain medications, and educate those on the REAL need for these medications. With the E-Force Database, and other laws & legislation put into effect, you would think legitimate pain patients were not affected by this, BUT, they ARE the ones being affected by this. Drug addicts will get their drugs, any way they can; Legitimate pain patients do not have those options. We are at the mercy of a healthcare system, which at this point seems terrified & bullied by LE/DEA, to NOT treat them. This has got to stop. Thank-you Mark for writing this article! Bravo! E11

  10. Austin at 11:53 am

    Something should be done about this. Before I was in chronic pain I didn’t care either… This issue is getting worse and worse why are the pharmacists scared to do their job. Whoever is scaring them needs to stop or simply put descent rules in place so that good honest people don’t suffer. I did not plan or ask to have a devastating back injury with sciatica and nerve pain and crushed discs. These medications enable me to work daily. To function to block the pain. Thebpils have gotten so expensive only the people diverting them can afford them and the people sellin at those prices are the only not worried about the Consequences because their making so much money off of each perscription

  11. Bridgette LaPorte Berner at 1:46 am

    Sick and dying people all over Florida my aunt has already committed suicide and I have heard many others talk the same as she did before she took her life. If this is Floridas way of trying to rid the state of dealers and druggies well its not working its back firing hello wake up Mr President and take a look at what your doing to the people who served your country and that are retuired and just expect to get their pain medication to live a normal day not be stuck in a bed like I am right now and have been up all night in pain not able to find a comfortable position at all. This state needs help and there needs yo be a systrm of some sort put unto effect immediately my spelling is off but you get what I mean. I am not just a moocher off the state by collecting as I do I am seeking part time employment every week and I go to college half time with only a few courses left and I will have obtained my Paralegal degree and general ed degree and you better bet your bottoms that if I dont have my medication by then I will for sure go to work for a non profit law office and continue to speak my mind and help all of my other sick and suffering needlessly from Floridas judicial system. I have said my peace now everyone that has wanted to speak up nows your time you see I took up two spots to get my point across its your turn and you can do it Donna and I believe in you say whats on your mind we are behind you a million and one percent!!!!!

  12. Bridgette LaPorte Berner at 1:36 am

    I do not have as many ailments as the above forementioned but darn close. I have had three different scripts written for me by my specialist and could not fill one for two weeks so I took it back got a different one and same and so on needless to say I still have yet to get my meds filled I was dumb enough to mail my last one to CVS not knowing until after mail went out they dont fill class two meds by mail. I dont have the money to pay for another appt or for the gas to go get another script just to find out my regular two pharmacies I use still cannot get them. I tried from Deerfield Bch all the way to Clearwater in Pinellas county to get my meds filled and either they were out or they would not do out of county which was only two of the I lost count number of pharmacies I checked in person. I am disabled I am not supposed to drive or walk over 30 min tops and I have ovet done it so much I have had to go to ER for dehydration and exhaustion. I have type 4 adnemyosis which is a step away from edometriosis along with scoliosis sciattica a two failed jaw surgeries a broken collar bone many herniated bulging and severe dengenerativr dpine disease. I have to get shots every month to treat the uterus which causes horrible side effects and I have share of cost medicaid on disability of 773 a month and unemployment of 474 a month but my share of cost i have to meet is 1600 before medicaid will pay any of my bills. I can barely afford my primary visit a month and my main meds for hormone treatments and now I have to pray CVS sends me back my last script and if I can find it at walgreens the cheapest place for them it will cost me 73.00 me 73.00 more dollars and I raise three kids ages 10, 11, and 14. My daughter will be graduating high school up in Pinellas nrxt week and without medication I dont know how I will be able to drive up there and be there for her ceremony. So yes the drug dealers need to stop paying cash for our meds that we need and selling them on the street for five times what they pay so the syatem can stop making their profits by trying to bust them or whatever its riduculous it has nothing to do with the

  13. Lymelady at 6:42 pm

    Mark, Thank you for writing about a topic that here in Florida seems to be taboo, unless it is written about how terrible pain medication are. I know for a fact that the REAL PAIN PATIENTS who are prescribed pain medication aren’t looking forward to their next appointment with the doctor like the junkies do. People who are in pain have diseases and injuries that they spend most of the time going to neurologists or some other type of specialist. Some of us see 3 or more specialists a month. We take other medicine for our conditions as well, not just narcotics for pain. Being in pain is not living. We lose out on working, family time and plain quality of life! Sadly some are so desperate to stop being in horrible pain that they commit suicide.
    Not being able to fill prescriptions is not right! We waste money on gas driving from pharmacy to pharmacy, just to be told “sorry we have given out our allotment for the month and will not have any until next month. Sometimes our whole order doesn’t come in and we only get 2 bottles”. Try being in horrible pain and spend 3 hours or more doing this. For me it is awful.
    I have been sick for almost 4 years. I went undiagnosed for a long time. This allowed my disease to get worse during that time. Finally I have been told that this disease will not get any better. But I still have not given up!!!
    The state of Florida MUST allow the people who are sick to have the necessary medications that are needed. Whether it be narcotics,chemo or IV antibiotics for lyme disease. We do have a GOD GIVEN RIGHT to live with out pain!

  14. Jeanne Hyatt at 5:32 pm

    There certainly is a problem in Florida and also in increasing numbers of other states, as well. People need to be aware that the “War on Drugs” has now reached your local, everyday pharmacy, not to mention your doctor’s office and now legitimate chronic pain patients are suspected criminals. I have been a chronic pain patient for 17 years. After 11 years of trying every non-narcotic medication and countless non-drug therapies with absolutely no effect, I finally asked my doctor for something “stronger”. Finally, I could function as a normal person! Finally, I had pain relief. Not a high, not a buzz, just the simple eradication of pain! But in January of this year, my right to be able to function began to be infringed upon. Because of having to do the “pharmacy crawl” each month since….traipsing around to different pharmacies trying to find one that had my medication in stock, being given strange looks and conflicting information about the reasons why each pharmacy did not have my legal prescription in stock, all in desperation so that I could remain able to function without going through withdrawal and having to basically subsist, crippled in pain and bed-bound, I finally gave up and asked my doctor to give me something, anything that would work. I went back on the drug and dosage that stopped being effective a year ago. I am under-medicated and have significantly reduced ability to function. But I am one of the lucky ones because I can still function somewhat. This is insane! All because of FEAR. All because of the DEA’s harassment of pharmacists resulting in them being threatened to lose their licenses. The family doctors in Florida gave up long ago. Because of their fear of the DEA’s tactics we were forced to see pain management specialists. Now the pain management specialists are being threatened so much that even they are caving in. I was just told on the day of my last appointment with my board certified pain management specialist that he is no longer seeing his pain patients. I had to scramble to find another doctor [not that easy at all!] and managed to suspend drug withdrawal by the compassionate prescribing by my family doctor of a temporary prescription to tide me over until that new appointment [not that easy, either]. I pray this new doctor will not suddenly decide to give in to the fear. With 98% of what I read in the media being skewed information and old statistics, most subscribing to “opioiphobia” and senseless hysteria, the future doesn’t look good. God forbid you have chronic pain in America today! What state, what country do I need to move to in order to be treated adequately and not as a common criminal for having the misfortune of suffering from chronic, non-malignant pain?

  15. sheresa at 3:34 pm

    My husband has been on pain meds for almost 10 years and does not abuse them !!! This is craxy that the people that truly need them and take them with doctors orders and are legal disabled are having such a hard time finding there meds, if the DEA wants control on it so bad have them open a local office in each county and let all of the scripts come through them and put all of the other pharmacies out of business or make it where they are not scared ni fill legitimate scxripts for honest patients. SOMETHING HAS TO BE DONE PEOPLE DO NOT DESERVE TO HURT BECAUSE OF OTHERS ABUSING THE MEDICINE!!!!

  16. Donna Ratliff at 3:17 pm

    Thank you Mark for helping to get the word out on the horrible crisis going on in Florida now. Yes, all of this happening right this minute. I get reports from people everyday that are headed in this direction or are already there. I just found out that.. That Walgreens pharmacy store is rejecting all prescriptions for pain medications that are written from doctors that accept cash from patients. Does anyone know how many patients do not have insurance? or are not insurable because of their health conditions? A whole lot!! A primary doctor refers a patient to pain management because they’re allowed to write for these medications so the patient then has to pay cash for both doctors. Now the pharmacies will not accept a legal prescription for any board certified doctor that accepts cash? Where is the common sense of this? Where is the compassion? Are we not living in America? We are supposed to have a birth given right to have our pain treated. We have databases coming up in all states, but that is not good enough? The tables have tilted so far, that a doctor’s expertise and writing a prescription is NOT good enough?? I must dreaming here. Something is very wrong with all this. People wake up and fight for your rights!!
    Lyme disease was not an epidemic 10 years ago. We have more people, with pain conditions that can not be cured. We need pain medicine to be available and if a board certified pain specialist writes the prescription than it is necessary.

  17. Thomas at 5:28 am

    I am a chronic pain patient and have gone through the same thing. I resorted to using mail order service, but now you cannot be classed to medications without health insurance which I don’t because I am the working poor.
    Because I couldn’t get my medicine I cannot work I got laid off and now I have no money for anything and I’m going to die soon.
    I have been cpp for 7 years now I have diabetes with chronic neuropathy, I have arthritis of the spine the center of my spine is slowly closing in there’s no surgery that can never possibly fix that.
    It is impossible to get the medicine that makes me feel like I can get out of bed and working the entire day.
    I wanna know jus resting the politicians that allow this to happen in the first place?
    Oxy codone was invented in the 18 hundeds. It was no mystery that this drug could be used as synthetic heroin. But I think of pharmaceutical companies big money pushed it through to work anybody could dole these pills out as they saw fit. Anybody with the least amount of brain cells woulda been able to tell you there’s gonna be abuse there.
    Haven’t heard 1 politicians name in the news about being arrested for allowing this to happen. If you’re going to go to these links they have to go to the truth links necessary.
    Everyday I stay depressed as I look for jobs I know I can’t even work.
    I don’t know how much longer I can carry on this way.